what ladies should know about family planning

• The 2 Types And Their Side Effects

We have 2 major types of family planning. They are: The Natural family planning method. The Artificial family planning method.

(A) THE NATURAL FAMILY PLANNING METHOD:

It is also called fertility awareness or the Rhythm method. This is a method of birth control that does not use any drug or devices. it relies on abstinence from sexual intercourse during the most fertile phase of a woman’s menstrual cycle. It consists of the basal body temperature method, the calendar/rhythm method, standard days method, symptom thermal Method, Breastfeeding, lactation Amenorrhea method and the cervical mucus method. The Natural FP is also used by some Faiths who do not believe in artificial FP e.g. The Roman Catholic Church

The Natural Family planning is used in two  ways

To prevent pregnancy or to Target the most fertile time for getting pregnant. I will explain briefly on this method: Under the Natural family planning method are:

(1) The Basal Body Temperature: This is the body’s temperature at rest. A woman’s resting temperature rises between 0.4°F and 0.8°F on the day of ovulation and it stays elevated until the next menstrual period. In this method the woman needs to check her temperature every morning before getting out of bed using a special (basal body) thermometer.

Note: A woman will be most fertile during the two to three days before the temperature rises.

(2) THE CERVICAL MUCUS METHOD

This method is also known as the Billings method. Right before ovulation, the mucus from the cervix changes from being cloudy and scanty to being clear and slippery. The consistency of ovulation mucus is like that of an egg white and it can be stretched between the fingers. After the ovulation the mucus tends to dry up again. So this method is checked by using (inserting) clean hands to feel the mucus everyday, then write the result on a chart. This will help the woman know when she is to ovulate.

Let’s know that Natural Family Planning is not something you do periodically or in few days it’s something you do everyday and over several months. In fact I call it operation survey yourself bBecause it helps you understand yourself more

Note: if the woman has an irregular period she should not use this method of contraceptive let her choose from other methods.

(3) THE CALENDAR METHOD

This method helps you predict your fertile days by tracking the length of your cycles over several months. So how can we use this method. You must keep track of your menstrual cycle for at least 6 periods (6months) and this should be done using a calendar. How to do tracking with a calendar

-Mark the first day of each menstrual cycle for 6-12 months

-Count the total number of days between each cycle ( from first day of one period to the first day of the next period)

-You should chart at Least 6 cycles -Find the shortest cycle in your records -Determine the first day of your fertile period by subtracting 18 days from the shortest cycle. -Determine the last day of your fertile period by subtracting 11days from the longest cycle.

Example:  Zino’s shortest cycle is 23days and longest cycle is 31days Shortest 23-18= 5, Longest 31-11= 20.

So Zino’s fertile period is from the 5th – 20th day of her cycle i.e. 16 days. So she has to abstain from sexual intercourse during this period every month.

Note: if the woman has an irregular period she should not use this method of contraceptive let her choose other method.

(4) STANDARD DAYS METHOD

This method can only be used by women whose menstrual cycles are 26-32 days long. If she has more than 2days longer or shorter cycle within a year, then this method would be less effective for her. Steps in this method:

-Keep track of the day’s of menstrual cycle then count the first day of monthly bleeding as day 1

-Avoid unprotected sex on day 8-9 cause it’s considered as fertile days.

-The couple can have unprotected sex on all the other days of the cycle and from day 20 until next monthly bleeding begins.

-The couple can use memory aids e.g cycle beads to count.

(5) SYMPTOM THERMAL METHOD

this is a combination of three methods listed above. They are: the calendar method, cervical mucus and the basal body temperature.

(6)  BREASTFEEDING, LACTATION AMENORRHEA METHOD (LAM)

In general, Breastfeeding delays the return of fertility at postpartum. However LAM is a contraceptive method based on exclusive Breastfeeding (6months).

Note: Baby sucking on the mother’s nipple causes a surge in maternal prolactin which inhibit estrogen production and ovulation.

(7) COITUS INTERRUPTUS

This is also known as the rejected sexual intercourse, withdrawal or pull-out method.  In this method, the penis is withdrawn from the vagina just before ejaculation so that ejaculation takes place outside the vagina. In this way semen is prevented from entering the uterine cavity and pregnancy does not take place. It is more effective when used in combination with another method eg standard days method.

Advantages

*It involves no cost, *It does not require any other device., *With self control and discipline it can be fairly effective, Disadvantages, *It requires a great deal of self control, *Slightest delay in withdrawal can lead to pregnancy. *Pre- ejaculatory fluid contains enough quantity of semen that lead to pregnancy. Thus failure rate is very high.

(B) ARTIFICIAL FAMILY PLANING

This method involves the use of chemicals or barriers in killing or preventing sperm from entering the uterus, hormones to trick the woman’s body into believing fertilization shouldn’t take place and surgery to prevent eggs or sperm from being released. TYPES: (1) Barrier Method (2) Hormonal Method (3) Emergency Method (4) Permanent Method

BARRIER METHOD

This method prevents Spermtozoa from entering the uterus either  by chemical e.g spermicide or mechanical/physical obstruction eg condoms, cervical caps and diaphragms:

(1) Diaphragm: It’s a dome shaped latex cap that is coated with spermicidal gel or cream and then placed high in the vagina before intercourse. The dome of the diaphragm covers the cervix.This prevent sperm from entering the cervix and also immobilize sperm near the cervical canal.

Advantages

*Can be worn by any client without discomfort, *Protects against some STI, *Reduces risk of cervical cancer * can be inserted up to 6 hours before before sex to avoid interruption

Disadvantages

*Not readily available in Nigeria *May be expensive for some client *Causes/increases the risk of Urinary Tract Infection *Requires Medical Examination.

(2)  CONDOMS

Condoms are mechanical barrier devices used during sexual intercourse to reduce the probability of pregnancy or sexually transmitted disease. Types of condom: we have the

1. Male condom: which is worn over the erect penis, It could be in latex rubber condom which is more common (and modern), condoms made from natural tissues,and condoms made from synthetic materials (soft plastic).

1. Female condoms: which is a sheath of polyurethane. It’s inserted into the vagina before genital contact. It has two flexible ring .a removable ring at the closed end to aid insertion and a fixed ring at the open end that sits on the vulva to hold the condom in place.

Advantages

*No medical prescription required

*its cheap, Protect against some STIs

Disadvantages

*Decreases sexual enjoyment

*It may burst or slide off a flaccid penis during withdrawal

*For the female condom application involves the woman touching her genitals.

(3) CERVICAL CAP

This is a soft rubber cup to which spermicide is added before it is placed over the cervix. It kills sperm.

(4) SPERMICIDES

These are chemicals placed in the vagina to immobilize or destroy sperms.They are available in different forms

*Creams *Jellies *Suppositories, *Foam, *Films and *Tablets

The active ingredient in most spermicidal is Nonoxynol-9 which also offers protection against STD.

Advantages:

*No prescription is required *It has no effect on breast milk *It is reasonably cheap

Disadvantages:

*May produce burning sensation *May increase risk of HIV transmission *Some may melt in hot weather.

(5) HORMONAL METHOD

This birth control method works by suppressing ovulation and also causes the cervical mucus to thicken thereby making it difficult for sperm to get through the cervix to the uterus. There are 2 main  classes of Hormonal contraceptive

1. Combined contaceptives: Contains both estrogen (ethinylestrondo) and progestin.
2. Progestin only contraceptive: Contains only progesterone (progestin)

Hormonal contraceptive comes in different form’s

Oral contraceptive pills

Combined Oral Contraceptive(COCs): Most common is colloquially taken once a day for 21 days followed by 7 days break(contains 28 tablets. 21 tablets are the active pills and the remaining 7 tablets have a different colour and are non active tablet)

Progestin only pills, POPs(minipills): This is taken1 once per day it contains synthetic female hormone in the family of progesterone E.g Exlution, Norgestrone, Femulen 0.5 etc

Emergency Contraceptive Pills (ECPs): This is used for women who had sex without any type of birth control or if she thinks her method has failed. It is usually taken before 72hours after unprotected sex.

Injection: These are long acting contraceptive containing combined estrogen and progesterone or progestogen only. Its given intramuscular.

Skin patches: This is applied to the skin and  worn continuously.

Intra Uterine Contraceptive Device (IUD): It’s a small plastic T shaped object with an attached string inserted in the uterine cavity to prevent pregnancy. It releases synthetic progestin hormone that changes cervical mucus, fallopian tubes and the uterine lining, it also stops or slows sperm and egg. Note: It lasts for 3-12years. Insertion can cause a few minutes of pain, but removal is fast and easy.

We have 2 types

1. Non medicated, made of inert plastic E.g:Lippe’s loop.
2. Medicated, made of plastic with copper sleeve or wire around it. Contains hormone Eg:copper T( Cu-T 380A)effective for 10-12 years Copper T (current 200)effective for 3years etc

Hormone releasing IUD’s: e.g prosgestasert, it does not inhibit ovulation but interfere with implantation in endometrium, thickening of cervical mucus.

Advantages

1. Highly effective
2. May be efficacious if inserted up to 7 days after intercourse
3. Generally well tolerated.

Disadvantages

(1) Not cost effective for short term use

(2) Not recommended for  women with STIs and also can increase a woman’s risk for STIs.

(6) INTRA UTERINE CONTRACEPTIVE

DEVICE (IUD)

It’s a small plastic T shaped object with an attached string inserted in the uterine cavity to prevent pregnancy. It releases synthetic progestin hormone that changes cervical mucus, fallopian tubes and the uterine lining, it also stops or slows sperm and egg. Note: It lasts for 3-12years. Insertion can cause a few minutes of pain, but removal is fast and easy.

We have 2 types

1. Non medicated? made of inert plastic e.g:Lippe’s loop??not available in Nigeria
2. Medicated made of plastic with copper sleeve or wire around it.

(7) IMPLANTS

These are also called (LARC)Long Acting Reversible Contraceptives. Implants are inserted under the skin of the inner upper arm and contain progesteron only.

(8) SURGICAL METHOD

This includes sterilization

* Tubal sterilization for women .* Vasectomy for men.

Vasectomy: It is a surgical procedure done under anaesthesia. A small incision is made on each side of the scrotum and the vas deference is then cut and tied or blocked. The vas deference is the tube that carrys sperm from the testicles to the opening of the penis.

Advantages

*Vasectomies are VERY effective.

*Vasectomies are permanent and one of the most effective kinds of birth control

Disadvantages

*It causes regrets for men who later have a change of mind about conception e.g A man who lost his wife or had a divorce and wants to re-marry may want to make the new wife pregnant.

*it does not protect against STIs

*Bleeding may result in haematoma.

*Reversibility is difficult and expensive

(9) TUBAL LIGATION

This involves blocking the fallopian tubes by cutting them, electrically sealing them or putting clips/rings on them thereby preventing the passage of both sperm and ova. The operations performed are

*Laparoscopy

*Culdoscopy

*Colopotomy(incision into the vagina)

Advantages

*Tubal ligation is a permanent method of birth control offering immediate and highly effective protection against unexpected pregnancy.

*The woman might forget to take a birth control pill, but once  tubes are tied, there’s no chance of human error

*It doesn’t affect a woman’s hormones unlike birth control methods such as the pill and the shot, tubal ligation doesn’t change the levels of estrogen and progesterone flowing through a woman’s body. She will still get her period, and it won’t affect her mood or sex drive.

Disadvantages

*It’s very expensive to reverse. Yes, the woman can change her mind later. Surgery can re-open tubes, but the success rate depends on her age and how much of the tube was left over after the original surgery.

*Most often, there could be an accidental injury to the bowel, bladder, or arteries which may lead to complications for the lady.

*There’s still a very small risk of getting pregnant. And there’s a greater chance that, if it does happen, the pregnancy will be ectopic, meaning the fertilized egg implants somewhere other than the uterus. An ectopic pregnancy can become life-threatening especially if it’s not quickly detected.

*It does not protect against STIs

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